Combinations of drugs may be better for high blood pressure treatment in certain people who need more effective high blood pressure control.

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According
to the U.S. Centers for Disease Control and Prevention, about 70 percent of
people with high blood
pressure are able
to get it under control by taking medication. While some patients can try adopting
healthy lifestyle changes, like a well-balanced diet and an increase in exercise, to
bring their blood pressure back into the normal range, others will need the
assistance of high blood pressure drugs — and possibly two or more
different medications — to gain high blood pressure control.

There
are many types of hypertension
medications
available, including ACE inhibitors, beta blockers, calcium channel blockers,
angiotensin II antagonists, vasodilators, and diuretics. Often, combinations of
these drugs can be used with very good results.

“Treating
hypertension does not equal controlling hypertension,” says David Montgomery, MD, PhD, senior fellow
in the cardiology department at Northwestern University in Chicago. “Control is
said to have been attained when blood pressure goals (usually 120/80 mmHg) are
met. Controlling hypertension can be difficult and often requires more than one
class of hypertension medication. Some people take three or four medications to
control their blood pressure.”

Combination High Blood Pressure Medications

True
combination medications are usually one pill that contains two types of
prescription medication. This can be beneficial because it’s easier to remember
to take one pill instead of two, and some medications are less expensive when
combined into a single drug. Some examples of this are Lotensin HCT, a
combination of benazepril (an angiotensin
converting enzyme, or ACE, inhibitor) and hydrochlorothiazide (a diuretic), or Tenoretic,
a combination of atenolol (a beta blocker) with chlorthalidone (a diuretic).

“We
can often achieve adequate blood pressure control with lower doses of two drugs
(in a single pill) and in doing so avoid the side effects that often accompany
higher dose medications,” says James D. Joye, DO, director of research
and education in the Heart & Vascular Institute at El Camino Hospital in
Mountain View, Calif.

Choosing the Right Combination Blood
Pressure Treatment

With
so many classes of blood pressure medications and so many possible
combinations, there really is no one right choice for high blood pressure
control — it all depends on the patient and his or her particular
health situation. That said, one commonly prescribed combination is a diuretic
and an angiotensin receptor blocker. Diuretics help lower blood pressure by
encouraging the body to release extra fluid and sodium through urination, while
angiotensin receptor blockers stop a particular chemical from constricting
blood vessels.

Another
popular pairing is a calcium channel blocker or beta blocker with an ACE
inhibitor. Calcium channel blockers cause blood vessels to dilate while beta
blockers lower the heart rate and reduce cardiac output. ACE inhibitors expand
the blood vessels.

“The
pros and cons of the combinations can be complicated,” says Dr. Montgomery. “It
is important to ask and learn about each medicine in your hypertension regimen.
No one combination is right for any one category of people — certain
blood pressure medicines have other effects and are used for more than just
hypertension.” Factors your doctor will take into account when prescribing blood
pressure drugs include your gender, race, any other health conditions, and
other medications you’re taking.

“The
decision to use each medicine has to be cahrefully considered on a case-by-case
basis,” explains Montgomery. For example, someone with congestive heart failure
might benefit from a combination approach that includes a diuretic (to help rid
the body of the excess fluid that occurs in this condition) and an ACE
inhibitor. A patient with a rapid heartbeat might do well on a combination that
includes a beta blocker or one of the calcium channel blockers that can keep
the heart rhythm in check.

Ultimately
it may be a process of trial and error, but with so many medicine combinations
for your doctor to choose from, it’s very likely you’ll find the one that works
best for your high blood pressure control.

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